Helen McEntee (Meath East, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after “That” and substitute the following:“Dáil Éireann resolves that the Nursing Home Support Scheme (Amendment) Bill 2016 be deemed to be read a second time on this day six months, to allow the Minister of State for Mental Health and Older People to consult with the public and other key stakeholders and to examine some important issues with the Bill having regard to the fact that the Minister of State is already preparing a set of policy options for the development of a regulatory regime for home care providers in tandem with a funding model for the provision of care in the home.”

I thank Deputy Willie O'Dea for bringing forward the Bill. It allows us to open up a much wider discussion on the care of our elderly, an issue that affects many people. God willing, the one certain thing in life is that we will all get old. While statistics show we are living longer and healthier lives, we all want to ensure that if that care is needed, it is there.

As Minister of State with responsibility for older people, my priority is to ensure our older people get the best care possible. I too would be bothered if people thought my only role was to put people in residential care. For many people, care can be provided in their own homes and communities with the people they love. Home care is an increasingly important part of the supports we offer to older people and will continue to increase in importance into the future as our aging population grows.

The Deputy is correct. According to the figures, the number of people over the age of 65 will double in the coming years while the number of people over the age of 85 will treble. Currently, 11 people per day are diagnosed with dementia, and this number will only increase. It is estimated that approximately 20% of the over 65 population receive some form of community-based support service annually from the State.

The HSE's national service plan sets a target to deliver 10.57 million home help hours, 16,750 home care packages and 190 intensive home care packages for clients with more complex needs. However, home care is not currently regulated by the State and not provided on a statutory basis. I know from discussing this topic with Members and people outside the House that we are in agreement on the need to consider carefully, as a matter of urgency, the future financing and regulation of home care.

It is the Government’s policy, as well as that of other political parties, to help older people to stay in their own homes and communities for as long as possible, with long-term nursing care seen as a last resort only after home care and other community-based supports have been fully utilised. People themselves want to stay at home and to ensure this happens we need to invest further resources into this area. Home care services provided through the HSE are provided on the basis of assessed health care need and there is no means-testing or personal contribution towards the costs involved. However, people are cared for at home under a wide variety of arrangements, both formal and informal. The HSE provides services both directly and through service agreements with private and voluntary sector providers. Traditionally, home care was viewed as providing a lower level of support than residential care, and not as an alternative to it. Increasingly, however, it is considered possible to support many people at home who would previously have gone into residential care. We have seen a decrease in the average length of stay in a nursing home from seven years to two years. To further support people remaining at home, we will require an increase in the amount and intensity of home care, as well as more effective integration with other supports, including nursing, therapies and other primary care services. We are working to provide a more viable alternative to nursing home care for a greater number of people.

Arrangements for home care provision have developed over the years with a significant local focus. While the HSE is incrementally developing a more consistent and coherent system, some legacy issues are still being worked through. Unlike the nursing homes support scheme, or the fair deal scheme as it is more commonly known, which is centrally managed in a unified way, there remains more variation than we would want to see in home care arrangements. For example, access to services can vary from place to place and at different times of the year, as Deputy O’Dea alluded to earlier.

The fair deal scheme is a coherent national system of financial support for those in need of long-term nursing home care. Participants contribute according to their means while the State pays the balance of the cost. Participants can contribute up to 75% while the overall budget for the scheme is €940 million. I believe what we need is a stand-alone statutory scheme designed for home care which recognises its particular characteristics. What we do not need is a scheme that pits home care against residential care. Both are necessary. A significant amount of detailed preparation needs to be done before final decisions are taken on the form of a home care scheme and the regulation of these services. We need to ensure this work is done as a matter of urgency.

This evening’s debate accelerates our deliberations. I acknowledge and welcome Deputy O’Dea’s intention to allow for home care services to be offered to people in place of long-term care in circumstances where these services are less costly on the State. This is my aim too but we need to ensure it is done in the correct manner and that the work I have already begun in this area is allowed to be completed.

I have discussed with Deputy O’Dea several concerns I have with this Bill, as it is currently worded and if it were to be introduced immediately. The Bill would have several unintended consequences for the operation of the national fair deal scheme and could actually jeopardise the efficient working of that scheme, in turn impacting on the wider health service. The Bill confers an entitlement to home care services. Funding made available for residential care under the fair deal scheme is not an entitlement. It is subject to available resources and a national placement list is in operation. Neither is there currently an entitlement to funding for home care which is provided on the basis of assessed need and also subject to available resources. A possible unintended consequence of the Bill is that the fair deal scheme could be overwhelmed. Inevitably, this could lead to delays in assessments and in granting approvals. Delays to the approval process have previously been shown to directly impact on the wider health services with knock-on effects of emergency presentations to acute hospitals and increased pressures in our emergency departments.

I am also concerned about one other area. Under the fair deal scheme, recipients pay 80% of their weekly income towards their care costs on the basis that they receive their food, heat and lighting. If this provision were applied to home care, older people could not survive on 20% of their income. Similarly, under the fair deal scheme, the value of a person’s home is assessed as an asset and a contribution of 7.5% per annum applies up to a maximum of three years. While this payment can be deferred, it assumes the person no longer lives in their house. Again, this is incompatible with the position of an older person who continues to live in their own house while receiving home care.

In saying that, however, let me reiterate that I agree wholeheartedly with Deputy O’Dea’s wish that care be provided to as many older people as possible in their own homes, where they are surrounded by the people and communities that they love. I know from travelling around the country and speaking to older people that this is the aspiration of so many, an aspiration which we are all working to deliver. The development of a statutory home care scheme is a priority for me and my Department. Intense efforts are now under way to make this a reality and I will bring the House up to date on these efforts.

The Department of Health is currently engaged in a detailed process which will determine what type of home care scheme is best, regarding both regulation and funding. In 2016, the Department of Health commissioned the Health Research Board to carry out an evidence review of international approaches to the regulation and financing of home care services. The examples of Sweden, Germany, the Netherlands and Scotland were used because they fit the type of model we are examining. This will be published shortly.

The Department is engaged in a mapping exercise of current service provision around the country, taking into account the scale and diversity of services funded by the HSE. This exercise is being carried out alongside future demographic projections. This work will be used to identify major policy options for a new home care scheme around the areas of regulation, financing, assessment and eligibility. Once this is complete, a public consultation will be launched to allow stakeholders, including older people themselves, their families and health care workers to express their views regarding a new home care scheme. It is my hope and intention at this stage that the consultation can be launched in May.

This debate is welcome. All Members are aware of the inconsistencies across the country in accessing home care and the need for more home care to be provided. This issue was highlighted in a touching and thought-provoking manner recently by Brendan Courtney in his documentary “We Need To Talk About Dad”, an important work on which I commend him as he is in the Gallery. All Members agree that we need more resources for home care. As I have outlined, I believe the way forward is developing a new scheme specifically designed for home care. It is important it is done as a matter of urgency. However, it is also important we recognise that the development of a funding model for home care services is a complex undertaking involving significant legislative, operational and financial resources. The Department’s intention is that regulation of the home care sector will be done in parallel with the development of such a scheme.

We all want the same outcome, namely, an affordable and sustainable home care scheme. I appreciate and warmly welcome the spirit of co-operation shown by Deputy O’Dea. On that basis, I propose that Second Stage be read again in six months’ time. This will allow the detailed work being carried out by the Department, including the consultation with stakeholders to take place. It will allow for further careful examination of several issues.

This is a priority for me and it is my intention to work with all Deputies, as well as other stakeholders, to an affordable and sustainable home care scheme for older people and future generations.

See this speech in context